From the Guidelines
Treatment for osteitis pubis should start with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and discomfort, as recommended by expert consensus guidelines 1.
Key Components of Treatment
- Rest and avoidance of activities that cause pain, particularly those involving the pelvic area
- Pain management with NSAIDs
- Physical therapy, including core strengthening exercises, pelvic stabilization techniques, and gradual return to activity protocols
- Compression shorts for symptomatic relief
- Consideration of corticosteroid injections into the pubic symphysis for persistent cases, with caution due to potential side effects
Treatment Approach
The treatment approach for osteitis pubis is multifaceted and focuses on conservative management.
- Initially, patients should reduce or avoid activities that cause pain
- Pain management includes NSAIDs like ibuprofen or naproxen for 1-2 weeks
- Physical therapy is crucial and should include core strengthening exercises, pelvic stabilization techniques, and gradual return to activity protocols
- Compression shorts may provide symptomatic relief by stabilizing the pubic symphysis
Persistent Cases
For persistent cases, corticosteroid injections into the pubic symphysis might be considered, though these should be limited due to potential side effects.
- Most cases resolve with conservative treatment within 3-6 months, though some may take longer
- Surgery is rarely needed but may be considered for severe, refractory cases
- Recovery requires patience as premature return to high-impact activities often leads to symptom recurrence
Underlying Cause
The condition results from repetitive stress causing inflammation at the pubic symphysis joint, which explains why rest and anti-inflammatory approaches are the cornerstone of treatment, as supported by recent guidelines 1.
From the Research
Treatment Options for Osteitis Pubis
- Conservative treatment measures, such as bed rest, non-steroidal anti-inflammatory drugs, and physical therapy, have been shown to be effective in treating osteitis pubis in non-athletic patients 2.
- Surgical treatment options, including arthrodesis, are available for patients who do not respond to conservative treatment 2.
- Corticosteroid injections have been used to treat osteitis pubis in athletes, with some studies showing rapid return to athletic activity 3.
- Physical therapy, involving strengthening of the abdominal and hip muscles, and improving range of motion of the hip, has also been used to treat osteitis pubis 4.
Treatment Outcomes
- A study of non-athletic female patients with osteitis pubis found that seven out of eight patients improved significantly with conservative treatment, while one patient required surgical treatment 2.
- A study of intercollegiate athletes with osteitis pubis found that corticosteroid injections resulted in a rapid return to athletic activity, with three out of three athletes returning to full participation within 2 weeks of injection 3.
- A systematic review of treatment options for osteitis pubis and osteomyelitis of the pubic symphysis in athletes found that there is limited evidence to support the use of any particular treatment modality, and further study is needed to determine the most effective treatment option 5.
Diagnosis and Symptoms
- Osteitis pubis is a painful condition characterized by inflammation of the pubic symphysis, and can cause symptoms such as groin pain, lower abdominal pain, and pain in the hip and thigh 6, 4.
- Diagnosis of osteitis pubis can be confirmed using radiographs, bone scans, and magnetic resonance imaging 4.
- Symptoms of osteitis pubis can be exacerbated by exercise or specific movements, and can be relieved with rest 6.